Age spots and brown spots, known as hyperpigmentation, are a common problem for many people.
Uneven skin tone and unwanted pigmentation can add years to your perceived age. Over time, your picture-perfect complexion begins to display hyperpigmentation in the form of undesirable dark patches, unsightly brown spots and speckles, and mottling in skin tone.
Many people feel uncomfortable about having age spots on their face and hands, so they turn to their doctors for help in removing them. Dr. Alina Sholar is an expert plastic surgeon and skin rejuvenation specialist from Austin, Texas. She explains how age spots form, how they can be prevented, and how they can be treated once they have already appeared.
The Cause of Brown Spots
Hyperpigmentation stems from enhanced production and uneven distribution of melanin, the skin’s predominant pigment, and can be one of the most difficult to treat skin conditions.
From a physiological perspective, the development of hyperpigmentation is a complex and often misunderstood process driven by biochemical and environmental factors. Pigmentation is also influenced by genetic and endocrine factors that modulate the amount, type and distribution of pigment found in the skin, eyes and hair. There are lesser known nutritional, pharmacological, and disease-related influences as well. In other words, it is not caused by just one thing.
Hyperpigmentation may result from sun damage, acne, inflammation, birth control, pregnancy, hormones, prescription drugs, or injury to the skin, which causes a series of cascading physiologic events that leads to increased melanin creation in the skin. Typical “age spots”, known as solar lentigo, are mostly caused by the sun’s UV radiation. They appear as oval, dark, flat areas on the skin. They can vary in size from freckle size to about 1/2 inch, usually appearing in areas that have been exposed to the sun, including the hands, face, shoulders, and arms. Age spots can be distinguished from freckles because age spots do not fade when there is little sun exposure, but freckles do.
Age spots are sometimes called sunspots and liver spots. Age spots are most common in adults over 50 years of age, but they can appear in younger people who spend time in the sun. Your doctor can diagnose these by inspecting your skin. Inflammation may also result in hyperpigmentation through several mechanisms.
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Post-inflammatory hyperpigmentation (PIH) appears as a result of inflammation and is caused by the direct stimulation of melanocytes via inflammatory mediators and reactive oxygen species such as superoxide and nitric oxide generated in damaged skin. When post-inflammatory hyperpigmentation is confined to the epidermis, there is an increase in the production and transfer of melanin to surrounding skin cells. Additionally, damage induced to epidermal cells can lead to the release of endocrine inducers of pigmentation such as melanin stimulating hormone.
It is estimated that medications may be the cause or contribute to 10-20% of the cases of both epidermal and dermal hyperpigmentation. The origin and effect of drug-induced pigmentation is variable depending on the medication and surrounding circumstances.
Finally, another type of hyperpigmentation known as melasma or mask of pregnancy is a dark skin discoloration that occurs at a deeper level in the skin and is due to a combination of hormonal changes, genetic predisposition, sun exposure, heat, and skin irritation. Although it can affect anyone, melasma is most common in women, especially pregnant women and those taking birth control pills or hormone replacement medications. Even small amounts of sun exposure can make melasma return to the skin after it has been treated or faded, which is why people with melasma often get it again and again, particularly in the summer.
Treatment of Brown Spots
Luckily, you do not have to live with brown spots. There are several clinical treatments from doctors like Dr. Alina Sholar that are able to reduce their appearance and bring you a more youthful look. Skin specialists can treat hyperpigmentation in several ways, depending on the root cause:
– Medications. Applying prescription bleaching creams (hydroquinone) alone or with retinoids (tretinoin) and a mild steroid might gradually fade the spots over several months. These medications may take some time to work, and they may create temporary burning, itching, redness, and dryness. Bleaching and tretinoin creams make your skin more sensitive to UV damage. You will need to wear sunscreen at all times during treatment and continue to wear sunscreen, even on cloudy days, after fading the spots.
– Laser and intense pulsed light. Some laser and intense pulsed light therapies destroy melanin-producing cells (melanocytes). These approaches typically require two to three sessions. Wounding or ablative lasers remove the top epidermis layer of skin.
– Freezing (cryotherapy). This procedure treats the spot by using a cotton-tipped swab to apply liquid nitrogen for five seconds or less. This destroys the extra pigment. As the area heals, the skin appears lighter. Spray freezing may be used on a small grouping of spots. The treatment may temporarily irritate the skin and poses a slight risk of permanent scarring or discoloration.
– Resurfacing Dermabrasion. Dermabrasion sands down the surface layer of skin with a rapidly rotating brush. New skin grows in its place. You may need to undergo the procedure more than once. Possible side effects include temporary redness, scabbing and swelling. It may take several months for pinkness to fade.
– Chemical peel. This method involves applying a solution to the skin to remove the top layers. New, smoother skin forms to take its place. Possible side effects include scarring, infection, and lightening or darkening of skin color, but are less common these days with newer, more advanced peels. Redness may lasts up to a few weeks. You might need several treatments before you notice any results. The age spot therapies that remove skin are usually done in a doctor’s and the length of time it takes to see results varies from weeks to months.
After treatment, when outdoors you’ll need to use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 and wear protective clothing. If an age spot is black, increasing in size, has an irregular border, has a combination of colors, or bleeds at all, you should go to the doctor at the earliest opportunity to be checked for signs of skin cancer.
Preventing Age Spots
Fortunately, if you have not yet begun to show age spots, they are largely preventable. It is best to avoid being in the sun between the hours of 10 a.m. and 4 p.m. The sun’s rays are most intense during this time of day.
You should use a broad-spectrum sunscreen with an SPF (sun protection factor) of at least 30. Apply this sunscreen liberally over all exposed skin and be sure to apply every two hours. Many people are good about applying sunscreen when they are going to the beach but neglect daily use of the product. Sunscreen should be worn every time you are outside for more than a few minutes.
It is also a good idea to wear tightly woven, light-colored clothing that covers your arms and legs. Broad-brimmed hats are best for sun exposure. It might be worth looking for sun protective clothing.
Combating Signs of Age
You may feel that the signs of skin aging like brown spots are not reversible. Fortunately, there are many ways that skin specialists like Dr. Alina Sholar can treat brown spots. Patients need to choose the best method that works for their situation in partnership with their skin specialists. Dr. Alina Sholar offers many of these solutions in her practice. Taking the time to invest in healthier skin and a more youthful appearance can give you the confidence you have always wanted.